CPT code 50590: Kidney stone treatment, shock-wave lithotripsy2026 Medicare rate & RVUs in South Dakota

Reports external shock-wave treatment to fragment a kidney stone, typically performed by a urologist without endoscopic or percutaneous stone access.

CMS RVU26DEffective Oct 1, 2026One payment locality41.9K Medicare services in 2024

In South Dakota, Medicare pays $732.93 for 50590 in the office and $493.77 when it’s performed in a hospital or facility.

$732.93Office (non-facility)
$493.77Hospital or facility
−3.6%vs the national office rate ($760.20)

Check a contract rate as a % of Medicare · 50590 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 50590 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in South Dakota
  2. What 50590 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 50590 covers

This service uses externally generated shock waves, directed toward a renal calculus, to break it into smaller pieces. A urologist typically performs the treatment in a hospital or ambulatory setting, using imaging to locate and target the stone. Unlike endoscopic or percutaneous stone procedures, treatment does not require access through the urinary tract or a percutaneous tract to reach the stone.

Report the service when the documented procedure is shock-wave fragmentation of a kidney stone. The record should support the treated kidney and the use of this treatment method. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For bilateral treatment, modifier 50 is paid at 150%. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. Assistant-at-surgery services are not paid; co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How South Dakota compares for 50590

Across 109 of 109 payment localities, the office rate for 50590 runs from $683.76 in Arkansas to $953.31 in San Benito County, CA. South Dakota pays $732.93. The RVUs are the same everywhere; the geographic indexes change the dollars.

50590 in South Dakota vs other payment areas
  1. South Dakota · this page$732.93
  2. Los Angeles, CA · California$832.80+$99.87
  3. Washington, DC area · District of Columbia$853.38+$120.45
  4. Miami, FL · Florida$839.45+$106.52
  5. Chicago, IL · Illinois$817.64+$84.71
  6. Manhattan, NY · New York$869.58+$136.65
  7. Alaska · Alaska$926.97+$194.04

Other areas in South Dakota first, then benchmark localities. Bars start at $0.

Every other payment area

50590 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$692.27$483.02
ArkansasArkansas$683.76$478.33
ArizonaArizona$741.86$510.13
Bakersfield, CACalifornia$788.67$526.56
Chico, CACalifornia$785.03$522.92
El Centro, CACalifornia$785.24$523.13
Fresno, CACalifornia$785.03$522.92
Hanford, CACalifornia$785.03$522.92

50590 rates by state

Office rate range in each state. Select a state to see its payment localities.

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$683.76

$926.97

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
50590 office rate range by state
State / territoryOffice rate rangeLocalities
AK$926.971
AL$692.271
AR$683.761
AZ$741.861
CA$785.03–$953.3129
CO$780.681
CT$806.061
DC$853.381
DE$752.841
FL$763.23–$839.453
GA$724.80–$775.832
GU$797.821
HI$797.821
IA$701.361
ID$706.491
IL$748.46–$817.644
IN$709.831
KS$701.351
KY$712.221
LA$712.39–$742.142
MA$778.20–$846.492
MD$764.83–$853.383
ME$712.61–$741.442
MI$730.63–$774.362
MN$742.911
MO$703.82–$741.053
MS$693.771
MT$760.121
NC$718.521
ND$735.801
NE$703.791
NH$771.501
NJ$813.80–$847.182
NM$735.191
NV$753.741
NY$727.96–$891.545
OH$725.661
OK$708.161
OR$746.40–$799.272
PA$725.08–$790.302
PR$764.001
RI$775.041
SC$723.581
SD$732.931
TN$704.711
TX$721.21–$779.408
UT$731.971
VA$741.31–$853.382
VI$764.001
VT$735.901
WA$775.77–$859.592
WI$714.941
WV$725.411
WY$749.521

See 50590 in every payment locality

How the 50590 rate is calculated

Each of 50590’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 50590

RVUs × geographic indexes × conversion factor

Office or facility?

Work9.53

9.53 RVUs× 1.000 GPCI

Practice expense12.00

12.00 RVUs× 1.000 GPCI

Malpractice1.23

1.23 RVUs× 1.000 GPCI

Adjusted RVUs

22.7600

Conversion factor

$33.4009

Medicare rate

$760.20

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact South Dakota inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,952

Code
50590
Physician work
9.53
Practice expense
12.00
Malpractice
1.23

GPCI2026.csv

94

Locality
South Dakota
Physician work
1.000
Practice expense
1.000
Malpractice
0.336
Office calculation for 50590 in South Dakota
ComponentRVULocality factorAdjusted
Physician work9.53× 1.0009.5300
Practice expense12.00× 1.00012.0000
Malpractice1.23× 0.3360.4133
Total RVUs21.9433
Conversion factor× 33.4009

Office rate, South Dakota$732.93

Office: (9.53 × 1 + 12 × 1 + 1.23 × 0.336) × $33.4009 = $732.93

Facility: (9.53 × 1 + 4.84 × 1 + 1.23 × 0.336) × $33.4009 = $493.77

Open 50590 in the RVU calculator

Payment rules and modifiers for 50590

50590 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 50590

Kidney stone treatment, shock-wave lithotripsy

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.08/0.83/0.09Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 50590

Kidney stone treatment, shock-wave lithotripsy

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

50590 without 50 · national office

$760.20

Kidney stone treatment, shock-wave lithotripsy

50590-50 · Bilateral: 150%

$1,140.30

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

How 50590 has changed in South Dakota

50590 · Office / nonfacility

$732.93

Effective 2026-10-01

The base rate is $39.52 higher than on 2025-10-01, moving from $693.41 to $732.93 (5.7%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release
  1. January 1, 2026

    RVU26A

    $693.41changed to$732.93

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 9.77 changed to 9.53
    • Practice expense RVU 11.22 changed to 12.00
    • Malpractice RVU 1.17 changed to 1.23
    • Malpractice GPCI 0.382 changed to 0.336

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $716.09changed to$693.41

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 11.28 changed to 11.22
    • Malpractice RVU 1.21 changed to 1.17

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $704.40changed to$716.09

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $721.07changed to$704.40

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 11.09 changed to 11.28
    • Malpractice RVU 1.15 changed to 1.21
    • Malpractice GPCI 0.364 changed to 0.382
  5. January 1, 2023

    RVU23A

    $734.55changed to$721.07

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 11.05 changed to 11.09
    • Malpractice RVU 1.17 changed to 1.15
    • Malpractice GPCI 0.347 changed to 0.364

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $739.58changed to$734.55

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 11.03 changed to 11.05
    • Malpractice RVU 1.14 changed to 1.17

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $738.24changed to$739.58

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 10.27 changed to 11.03
    • Malpractice RVU 1.13 changed to 1.14
    • Malpractice GPCI 0.368 changed to 0.347

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $733.04changed to$738.24

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 10.15 changed to 10.27
    • Malpractice RVU 1.08 changed to 1.13
    • Malpractice GPCI 0.389 changed to 0.368

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $725.40changed to$733.04

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 9.96 changed to 10.15

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $717.65changed to$725.40

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 9.80 changed to 9.96
    • Malpractice GPCI 0.395 changed to 0.389

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $711.65changed to$717.65

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 9.67 changed to 9.80
    • Malpractice RVU 1.09 changed to 1.08
    • Malpractice GPCI 0.400 changed to 0.395

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $713.50changed to$711.65

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 9.65 changed to 9.67

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $709.95changed to$713.50

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $705.66changed to$709.95

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 9.55 changed to 9.65
    • Malpractice RVU 0.91 changed to 1.09
    • Malpractice GPCI 0.416 changed to 0.400

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $695.78changed to$705.66

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 10.27 changed to 9.55
    • Malpractice RVU 0.95 changed to 0.91
    • Malpractice GPCI 0.432 changed to 0.416

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $695.78

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$732.93$493.77RVU26D
2026-07-01$732.93$493.77RVU26C
2026-04-01$732.93$493.77RVU26B
2026-01-01$732.93$493.77RVU26A
2025-10-01$693.41$534.59RVU25D
2025-07-01$693.41$534.59RVU25C
2025-04-01$693.41$534.59RVU25B
2025-01-01$693.41$534.59RVU25A
2024-10-01$716.09$545.99RVU24D
2024-07-01$716.09$545.99RVU24C
2024-04-01$716.09$545.99RVU24B
2024-03-09$716.09$545.99RVU24AR
2024-01-01$704.40$537.08RVU24A
2023-10-01$721.07$546.89RVU23D
2023-07-01$721.07$546.89RVU23C
2023-04-01$721.07$546.89RVU23B
2023-01-01$721.07$546.89RVU23A
2022-10-01$734.55$552.18RVU22D
2022-07-01$734.55$552.18RVU22C
2022-04-01$734.55$552.18RVU22B
2022-01-01$734.55$552.18RVU22A
2021-10-01$739.58$554.30RVU21D
2021-07-01$739.58$554.30RVU21C
2021-04-01$739.58$554.30RVU21B
2021-01-01$739.58$554.30RVU21A
2020-10-01$738.24$566.82RVU20D
2020-07-01$738.24$566.82RVU20C
2020-04-01$738.24$566.82RVU20B
2020-01-01$738.24$566.82RVU20A
2019-10-01$733.04$569.06RVU19D
2019-07-01$733.04$569.06RVU19C
2019-04-01$733.04$569.06RVU19B
2019-01-01$733.04$569.06RVU19A
2018-10-01$725.40$569.16RVU18D
2018-07-01$725.40$569.16RVU18C
2018-04-01$725.40$569.16RVU18B
2018-01-01$725.40$569.16RVU18AR1
2017-10-01$717.65$564.77RVU17D
2017-07-01$717.65$564.77RVU17C
2017-04-01$717.65$564.77RVU17B
2017-01-01$717.65$564.77RVU17A
2016-10-01$711.65$560.91RVU16D
2016-07-01$711.65$560.91RVU16C
2016-04-01$711.65$560.91RVU16B
2016-01-01$711.65$560.91RVU16A
2015-10-01$713.50$561.50RVU15D
2015-07-01$713.50$561.50RVU15C
2015-04-01$709.95$558.70RVU15B
2015-01-01$709.95$558.70RVU15A
2014-10-01$705.66$557.35RVU14D
2014-07-01$705.66$557.35RVU14C
2014-04-01$705.66$557.35RVU14B
2014-01-01$705.66$557.35RVU14A
2013-10-01$695.78$541.32RVU13D
2013-07-01$695.78$541.32RVU13C
2013-04-01$695.78$541.32RVU13B
2013-01-01$695.78$541.32RVU13AR

Price 50590 for an earlier date of service

Where the South Dakota rate applies

South Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 485 cities and communities in South Dakota. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Agar
  • Agency Village
  • Akaska
  • Albee
  • Alcester
  • Alexandria
  • Allen

Browse all communities in South Dakota

50590 billing questions

How does this differ from ureteroscopic stone treatment?

This code is for externally delivered shock waves directed at a kidney stone. Ureteroscopic treatment uses an endoscope passed through the urinary tract to reach and treat a stone.

Does the global period include routine follow-up?

Yes. The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care.

How is bilateral treatment reported?

When both kidneys are treated, report modifier 50; CMS pays the bilateral procedure at 150%.

How does the multiple-procedure reduction affect payment?

When procedures are performed in the same session, CMS pays the highest-valued procedure in full and the others at 50%.

Can an assistant or co-surgeon be reported?

CMS does not pay assistant-at-surgery services for this code. Co-surgeons and team surgery are not permitted.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 50590PPRRVU2026_Oct_nonQPP.csv, line 5,952 (RVU26D)
Geographic factors for South DakotaGPCI2026.csv, line 94 (RVU26D)

Open CMS sourceHow we calculate rates

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